Malignant pleural mesothelioma (MPM) is a relatively infrequent disease, whose incidence is estimated in western countries between less than 1 case/million/year among persons non exposed to asbestos and 100 cases/million/year among individuals professionally exposed to asbestos. The incidence of disease is expected to continue to increase in the next years, with a peak between 2015 and 2020.
Prognosis of MPM is generally poor: a recent study showed that in a comprehensive unselected population, median survival was 8.9 months. Reports from referral institutions concerning patients participating to clinical trials showed a slightly better outcome. A randomized study comparing mono-chemotherapy with cisplatin to the association cisplatin-pemetrexed (an antifolate drug) showed a median survival of 9.3 months and 12.1 months in the two arms, respectively, this later drug association is now considered the standard of care. Nevertheless, these results are globally discouraging because of the very low rate of long term survival. More recently, a treatment strategy based on the association of induction chemotherapy and radical surgery by extrapleural pneumonectomy resulted in 5-year survival rate of approximately 40% in patients with epithelioid mesothelioma, complete (R0) resection, and no mediastinal nodes involvement. However, only a minority of patients with MPM can benefit from this aggressive therapeutic strategy, because of advanced disease, histological type, advanced age or co-morbidities. In current practice less than 40% of patients with MPM receive chemotherapy and the remaining ones are offered only supportive cares. Identification of new prognostic factors would help in the understanding of disease progression and thereby patient management.